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Workplace Empowerment and Magnet

Hospital Characteristics: Making the Link
ARTICLE in JONA THE JOURNAL OF NURSING ADMINISTRATION AUGUST 2003
Impact Factor: 1.37 DOI: 10.1097/00005110-200307000-00011 Source: PubMed

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JONA
Volume 33, Number 7/8, pp 410-422
2003, Lippincott Williams & Wilkins, Inc.

Workplace Empowerment and

Magnet Hospital Characteristics
Making the Link
Heather K. Spence Laschinger, PhD, RN
Joan Almost, MScN, RN
Donnalene Tuer-Hodes, MScN, RN
Objective: To test a theoretical model linking nurses
perceptions of workplace empowerment,magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings.
Background: Strategies proposed in Kanters structural empowerment theory have the potential to result in work environments that are described in
terms of magnet hospital characteristics. Identifying
factors that contribute to work conditions that attract and retain highly qualified committed nurses,
such as those found in magnet hospitals, that can be
put in place by nursing administrators is extremely
important for work redesign to promote professional nursing practice.
Methods: Secondary analyses of data from 3 studies
were conducted2 of staff nurses and 1 with acute
care nurse practitioners working in Ontario, Canada.
The Conditions of Work Effectiveness QuestionnaireII, the NWI-R, and measures of job satisfaction were
used to measure the major study variables.
Results: The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics
of autonomy, control over practice environment, and
positive nurse-physician relationships.The combination of access to empowering work conditions and
magnet hospital characteristics was significantly predictive of nurses satisfaction with their jobs.
Authors affiliations: Professor and Associate Director of Nursing Research (Dr Laschinger), Lecturer (Ms Almost), School of
Nursing, The University of Western Ontario, London, Ontario;
Nurse Manager (Ms Tuer-Hodes), Stratford General Hospital, Stratford, Ontario.
Corresponding author: Heather K. Spence Laschinger, PhD,
RN, School of Nursing, The University of Western Ontario, London, Ontario N6A 5C1 (hkl@uwo.ca).

410

Conclusions/implications: These findings suggest

that nursing leaders efforts to create empowering
work environments can influence nurses ability to
practice in a professional manner, ensuring excellent
patient care quality and positive organizational outcomes.
Nursing once again faces a serious shortage of
nurses as experienced nurses approach retirement
and fewer individuals enter the profession. Recent
downsizing initiatives have often resulted in heavier
workloads for nurses, and reports of poor working
conditions, particularly in hospitals, abound in the
media. Patient safety is a major concern in this context in which fewer nurses are available to care for
patients with much higher acuity than in the past.To
address this problem, efforts must be made to improve nurses working conditions to retain nurses in
the system and encourage new recruits to the profession.
Magnet hospital research has shown that nurses
are attracted to hospital work environments that
promote autonomy and control over the practice environment and that foster good nurse-physician relationships.1 Aiken argues that these environments facilitate professional nursing practice. Nurses in
magnet hospitals have lower levels of burnout and
greater job satisfaction than nurses in nonmagnet hospitals.2-4 Furthermore, research has shown that hospitals with these characteristics have better patient outcomes, including lower mortality rates.5,6 Other
researchers also have demonstrated a link between
nurse-physician collaboration and mortality in intensive care units.7,8 Clearly, nursing administrators
would be well advised to ensure that these attributes
characterize their work environments.

JONA Vol. 33, No. 7/8 July/August 2003

To date, this research has focused primarily on

the provider and patient outcomes associated with
magnet hospital characteristics. Less work has been
done to identify basic organizational social structures that would promote the development and
maintenance of these features. Kanters9,10 notion of
structural empowerment is a plausible precursor to
magnetism in hospital work environments. Kanter
argues that social structures within the work environment that provide employees with access to information, support, resources, strong interpersonal
relationships, and opportunities to learn and grow
are empowering and allow employees to accomplish their work in meaningful ways.
For professionals, meaningful accomplishment
of work means being able to practice according to
professional standards. Nurses value work environments that provide opportunities to make decisions
based on their expertise and professional judgment
and to be involved in decisions that affect their
working conditions. Strong working relationships
with physicians and other health team members are
also critical to success. It is reasonable to speculate
that when nurses perceive their work environment
to be empowering, they will feel more supported to
practice in a professional manner and characterize
their work environments in magnet-like terms.
Thus, the purpose of the analyses reported here
was to test this proposition by examining relationships between nurses perceptions of workplace empowerment as described by Kanter and their perceptions of the presence of magnet hospital
characteristics as described by Aiken et al.1 This was
accomplished by conducting a secondary analysis of
data from 3 independent studies of nurses in separate work settings.

Theoretical Framework
Kanter9,10 argues that social structures in the workplace influence employee attitudes and behaviors to
a greater extent than inherent personality predispositions. Although personal characteristics play a role
in employees workplace behaviors, Kanter maintains that situational conditions can constrain optimal job performance, regardless of positive personal
tendencies or predispositions and, therefore, lower
organizational productivity. Kanter conceptualizes
power as the ability to mobilize resources to get
things done11(p210) and uses the analogy of an electrical circuit to describe how productive power is
achieved and maintained in the work setting. Power
is on when employees have access to lines of in-

JONA Vol. 33, No. 7/8 July/August 2003

formation, support, resources, and opportunities to

learn and grow. When these lines or sources of
power are unavailable, power is off and effective
work is impossible.These lines of power are sources
of structural empowerment within the organization.
According to Kanter, these lines of power emanate from the formal and informal systems within
the organizations. When jobs are constructed so that
there is a lot of discretion or flexibility in how work
is accomplished, are central to the overall purpose of
the organization, and are highly visible within the organization, they contain high degrees of formal
power. When strong relationships among superiors,
peers, and subordinates are encouraged within the
work setting, the resulting alliances confer informal
power. High levels of formal and informal power facilitate access to the lines of power and opportunity
that enable employees to accomplish their work
meaningfully.
Research Testing Kanters Theory
There is considerable support for Kanters theoretical propositions in the nursing population.12 Consistent support for the relationship between access to
empowerment structures, or lines of power and opportunity, and formal and informal power within the
work setting has been established in several nursing
populations.13-16 Perceptions of work empowerment
have been linked to many important organizational
outcomes, such as job satisfaction,14,17,18 organizational commitment,19,20 trust in management,17,18 accountability for practice,21 lower levels of job
stress,22,23 and empowering leader behaviors.15
Nurses perceptions of structural empowerment
also are empirically related to workplace characteristics that define magnet hospital settings; that is, autonomy,13,24 control over the practice environment,14,25 and
good nurse-physician working relationships.16 Although these studies were not specifically designed to
link Kanters theory of structural empowerment to
Aikens conceptualization of magnet hospitals, the
results support logical relationships between the
two concepts.
Laschinger et al24 reported the results of two
studies that linked work empowerment to two
facets of decisional power in nursing work settings:
(a) autonomy and (b) perceptions of participative
management in the work setting. In a study of 101
nurses in a large urban teaching hospital, significant
positive relationships were found between nurses
perceived access to empowerment structures and
autonomy (r 0.52, P .001). Formal and informal
power and job-related empowerment structures to-

411

gether explained 34% of the variance in nurses perceptions of autonomy in their jobs. In the other
study, nurses perceptions of empowerment explained 85% of their perceptions of a participative
management philosophy within the work setting.
In a study of 127 nurses in two US urban hospitals, Havens and Laschinger26 found significant relationships between nurses perceptions of workplace
empowerment and the extent of their decisional involvement in matters affecting policy and the practice environment on their work units (r .47 and
r .33, for hospitals A and B, respectively). In another analysis of these data, Laschinger and Havens14
found that empowerment also was strongly related
to control over nursing practice (r 0.625,P .001).
Access to empowerment structures and control over
nursing practice together explained 51% of the variance in job satisfaction. Huffman25 observed similar
correlations between empowerment and control
over practice in his study of 82 nurses employed in
two Canadian community hospitals (r .76,
P .001 and r .68, P .001, respectively). These
results are consistent with those of McCloskey,27
who found that autonomy was significantly related
to job satisfaction, organizational commitment, and
intent to stay on the job. These findings provide
support for Kanters contention that work empowerment is associated with employee involvement in decisions related to both the content and
the context of practice.
Although Kanters theory does not address collaboration per se, it is addressed in her concept of informal power; that is, strong alliances with key individuals in the organization who are involved in the
work to be accomplished. For nurses, this would include collaboration with physicians. Collaboration
with managers, physicians, and peers is critical for effective patient care. In a study of 63 Canadian nurse
practitioners, Almost and Laschinger16 found a significant positive relationship between perceptions of
workplace empowerment and collaboration with
physicians (r .42, P .0001). Nurse-physician collaboration was most strongly related to nurse practitioners perceptions of informal power and support.
The combination of empowerment and positive collaborative relationships with physicians explained
50% of the variance in nurse practitioners perceptions of job strain.
In another study, Laschinger and Havens14 found
that nurses ratings of relationships with physicians
were significantly related to staff nurses perceptions
of job satisfaction (r .58) and work effectiveness
(r .45).These findings are consistent with those of

412

Baggs et al,28 who found that nurse-physician collaboration was an important predictor of nurses satisfaction with decision making in critical care settings.
In a recent study, Upenieks29 established a link
between magnet hospital characteristics and Kanters theory of structural empowerment. She surveyed 305 nurses from two magnet hospitals and
two comparable nonmagnet hospitals to examine
differences in perceptions of the presence of magnet hospital characteristics, workplace empowerment, and job satisfaction. As hypothesized, magnet
hospital nurses were significantly more empowered
than those in nonmagnet hospitals (M 3.55 [.96]
and M 2.63 [.99], respectively, t 8.56, P .001).
These studies provide evidence to support the
hypothesis that structuring work settings to ensure
access to workplace empowerment structures in
hospital settings is likely to create work environments that are described in terms of magnet hospital characteristics.The results of magnet hospital research also suggest plausible links to Kanters
structural power in organizations.
Magnet Hospital Research
In a survey of 5006 staff nurses in 32 British hospitals, Rafferty et al4 found that greater control over resources was associated with higher levels of nurse
autonomy (r .65) and more involvement in decisions (r .21).This is consistent with Kanters claim
that access to resources and support in the work setting facilitates employee involvement in work
processes and, thus, the accomplishment of work.
Good nurse-physician relationships were significantly related to greater autonomy (r .38), decisional involvement (r .35), and control over practice environment (r .25). Nurse-physician
working relationships are a component of Kanters
concept of informal power in the organization,
which influences employees access to work empowerment structures. All of these magnet characteristics
were significantly (P .01) related to higher job satisfaction (r .42), less burnout (r .26), and positive
perceptions of the quality of care (r .53).
Other researchers have established links between magnet hospital characteristics and variables
related to structural empowerment. Magnet hospital
characteristics were associated with higher levels of
trust in management ( .56) and lower burnout
levels ( .62) in a study of 3016 Canadian staff
nurses by Laschinger et al.30 These variables explained 39% of the variance in job satisfaction. Similar effects were found for nurse-assessed quality.
Magnet hospital characteristics were associated with

JONA Vol. 33, No. 7/8 July/August 2003

higher perceptions of patient care quality ( .34).

The combination of magnet hospital characteristics,
trust, and burnout explained 40% of the variance in
perceptions of patient care quality. Loveridge et al31
also found a significant relationship between nurses
perceptions of control over their practice environment and burnout in a survey of 1004 California staff
nurses.
In another study, Aiken et al3 compared data
from the 13 original magnet hospitals with data collected from 7 magnet hospitals identified by the
American Nurses Credentialing Center (ANCC).The
latter group had significantly higher levels of nurse
autonomy (M 3.01 vs M 2.86) and nurse control
over the practice setting (M 2.95 vs M 2.65)
than those of the original magnet hospitals. Nurses
in ANCC magnet hospitals were significantly less
likely than nurses in the original magnet hospitals to
report feeling burned out (20.4% ANCC, 29.9% original), emotionally drained (42.2% ANCC, 51.6% original), or frustrated by their work (32% ANCC, 44.9%
original). Nurses in ANCC magnet hospitals were significantly more likely than nurses in the original
magnet hospitals to report that their units had adequate support systems (63% ANCC, 43% original)
and enough RNs to provide high-quality care (70%
ANCC, 47% original). A greater proportion of ANCC
magnet hospital nurses also reported that they controlled their own practice, participated in policy decisions, and had a powerful chief nursing executive
and that the contributions they made were greatly
appreciated. These characteristics are consistent
with predicted outcomes of empowered work environments described by Kanter.
The most compelling findings of the magnet research program pertain to the links between magnet
hospital characteristics and negative patient outcomes. Aiken et al5 compared Medicare mortality
rates of 39 magnet hospitals to 195 matched control
hospitals. After adjustment for differences in predicted mortality for Medicare patients, the magnet
hospitals had a 4.6% lower mortality rate, which
translates to 0.9 to 9.4 fewer deaths per 1000 discharges. In another study, Aiken et al6 compared 10
hospitals with dedicated AIDS units with 10 comparable hospitals treating AIDS patients on general
medical units. Of the 10 comparison hospitals, 3 had
been determined as being magnet hospitals during
previous research.32,33 Data were collected from 1205
patients and 820 nurses on 40 units. Patients with
AIDS in scattered-bed units in magnet hospitals had
lower odds of dying than did AIDS patients in any
other setting.34 Magnet hospitals also had significantly

JONA Vol. 33, No. 7/8 July/August 2003

higher levels of patient satisfaction,35 significantly

lower rates of nurse burnout,2 and lower rates of needle-stick injuries35 than did comparison hospitals.
Aiken and colleagues were among the first to
empirically establish a link between nursing working conditions and patient outcomes. This work is
extremely salient in current healthcare work environments characterized by increased nursing workloads and higher patient acuity and concerns about
both patient and provider safety. Identifying factors
that contribute to work conditions that attract and
retain highly qualified, committed nurses, such as
those found in magnet hospitals, that can be put in
place by nursing administrators is extremely important for work redesign to promote professional nursing practice.

Research Hypotheses
Based on theoretical expectations and the preceding
review of the literature, the following hypotheses
were tested in each of the 3 studies reported here:
1. Higher levels of workplace empowerment
are positively related to perceptions of autonomy, control over practice environment,
and collaboration with physicians within the
work setting (magnet hospital characteristics). Rationale: When nurses have access to
the resources and support, they must practice in a professional manner and are likely to
report high levels of autonomy, control over
the practice environment, and strong RNphysician relationships.
2. Higher levels of empowerment and magnet
hospital characteristics in nursing work settings are positively related to nurses job satisfaction. Rationale: Nurses who feel empowered to practice professionally by their
work environment are likely to be more satisfied with their jobs.

Methods
The studies reported in this article were surveys of
nurses conducted in three nursing populations (see
overview in Figure 1). Two of the studies surveyed
staff nurses: one used a large sample of nurses from
urban teaching hospitals throughout the province of
Ontario and the other used a sample obtained from
3 rural community hospitals in western Ontario.The
third sample consisted of acute care nurse practitioners who worked in hospital settings throughout

413

Study 1
Design:
Sample:
Measures:

Study 2
Design:
Sample:
Measures:

Study 3
Design:
Sample:
Measures:

Predictive nonexperimental design

233 randomly selected staff nurses employed in urban tertiary care hospitals
Conditions of Work EffectivenessII
Nursing Work IndexR
Global Job Satisfaction Questionnaire
Predictive nonexperimental design
263 randomly selected staff nurses employed in a network of 8 rural community
hospitals
Conditions of Work EffectivenessII
Nursing Work IndexR
Nurse Job Satisfaction Questionnaire
Predictive nonexperimental design
55 acute care nurse practitioners employed in urban tertiary care hospitals
Conditions of Work EffectivenessII
Nursing Work IndexR
Global Job Satisfaction Questionnaire

Figure 1. Methods.

the province. Measures of structural empowerment

and magnet hospital characteristics were the same for
each of the 3 studies, allowing comparison of results.A
global measure of job satisfaction was used in 2 of the
3 studies.These tools are described in the methods section for Study 1 to avoid repetition. In Study 2, the
Nurse Job Satisfaction Questionnaire (NJSQ)36 was
used.This tool is described in the instrumentation sec-

tion of Study 2. The instrument reliability estimates can

be found in Table 1.
In the following paragraphs, the methods and results for each study are presented separately. In the discussion section, the results of all 3 studies as a group
are interpreted in light of the study hypotheses. The
means and standard deviations for all measures used
in this study are presented in Table 2.

Table 1. Summary of Cronbach Reliability Coefficients for Study Instruments

Instrument
CWEQ-II
Opportunity
Information
Support
Resources
JAS-II
ORS-II
Global empowerment
NWI-R
Autonomy
Control over practice
Registered nurse-physician Collaboration
Satisfaction

Study 1
0.87
0.81
0.86
0.78
0.77
0.75
0.7
0.86
0.88
0.79
0.76
0.89
0.84

Study 2
0.82
0.79
0.85
0.83
0.76
0.67
0.65
0.83
0.87
0.78
0.75
0.85
0.88

Study 3
0.88
0.64
0.9
0.86
0.76
0.68
0.57
0.92
0.88
0.74
0.72
0.84
0.84

CWEQ-II, Conditions for Work Effectiveness Questionnaire-II; JAS-II, Job Activities Scale-II: ORS-II, Organizational Relationships Scale-II; NWI-R, Nursing Work Index.

414

JONA Vol. 33, No. 7/8 July/August 2003

Table 2. Means and Standard Deviations for Empowerment and Satisfaction Variables
Study 1 (n 233)

Study 2 (n 263)

Study 3 (n 55)

Instrument

Mean

SD

Mean

SD

Mean

SD

CWEQ-II
Opportunity
Information
Support
Resources
JAS-II
ORS-II
Global empowerment
Satisfaction

17.79
3.78
2.76
2.62
2.81
2.43
3.38
2.83
2.92

3.31
0.79
0.88
0.84
0.78
0.85
0.76
1.01
0.93

18.37
3.83
2.72
2.79
3.00
2.57
3.47
3.09
3.05

2.82
0.71
0.75
0.82
0.69
0.76
0.73
0.9
0.75

20.95
4.27
3.41
3.18
2.51
3.15
4.40
3.30
3.30

3.08
0.53
0.9
0.88
0.75
0.72
0.54
1.09
0.9

CWEQ-II, Conditions for Work Effectiveness Questionnaire-II; JAS-II, Job Activities Scale-II; ORS-II, Organizational Relationships Scale.

Study 1
Design and Sample

In this study, data from a subset of a longitudinal

study of 237 randomly selected staff nurses who
worked in urban tertiary care hospitals in Ontario
were used to test the study hypotheses. Nurses in
the larger study had responded to a mailed questionnaire designed to test a model derived from Kanters theory. Details of the study design can be found
in Laschinger et al.23 Nurses who were not involved
in management or educational roles were retained in
the sample for the analysis reported in this article
(n 233). Nurses from all areas of Ontario were represented in the sample. Nurses worked mostly fulltime (64.5%), in medical-surgical (33.3%), critical
care (34.7%), maternal child (11.9%), and psychiatric
(20.1%) specialty areas. Most were diploma prepared
(86.9%). Respondents averaged 44 years of age
(SD 7.70), with 19 years of nursing experience
(SD 8.17) and 10 years experience in their current workplace (SD 6.78).
Instrumentation

Three measures of Kanters concept of empowerment were used: the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), the Job Activities
Scale-II (JAS-II), and the Organizational Relationships
Scale-II (ORS-II). All instruments used a 5-point Likert scale, and items were summed and averaged to
yield subscale scores ranging from 1 to 5. Higher
scores represent higher levels of the construct.
The CWEQ-II, a modification of the original
CWEQ,37 measures nurses perceptions of their access to the 4 work empowerment structures described by Kanter: access to opportunity, information, support, and resources. The CWEQ-II consists

JONA Vol. 33, No. 7/8 July/August 2003

of 12 items (3 for each of Kanters empowerment

structures). The construct validity of the CWEQ-II
was substantiated in a confirmatory factor analysis
that revealed a good fit of the hypothesized factor
structure (2 279, df 129, Comparative Fit Index
[CFI] .992, Incremental Fit Index [IFI] .992,
Root Mean Square Error of Approximation [RMSEA]
.054). The CWEQ-II also correlated highly with a
global measure of empowerment (r 0.56), providing additional evidence of construct validity. Details
of this analysis can be found in Laschinger et al.23 The
JAS-II is a 3-item measure of staff nurses perceptions
of Kanters concept of formal power. The ORS-II is a
3-item measure of staff perceptions of Kanters informal power.38 Cronbach alpha reliabilities from previous studies ranged from 0.79 to 0.82.18 In this study,
alpha reliability coefficients for the revised scales were
within acceptable limits (range: 0.70 to 0.86).
Laschinger et al23 recently validated the factor
structure of these measures of empowerment.
Based on these results, a total empowerment score
was created by summing the subscales of the
CWEQ-II, JAS-II, and ORS-II (score range: 6 to 30). In
this study, Cronbach alpha for this scale was 0.87
(Table 1). A 2-item global empowerment scale was
included for validation purposes. Consistent with
previous research, the alpha reliability of this measure was .86. The CWEQ-II correlated positively
with the 2-item measure of global empowerment
(r .56), as did the total empowerment score
(r .58), further supporting the construct validity
of the modified instrument.
Magnet hospital characteristics of the work setting were measured by the Nursing Work Index
(NWI-R).39 To allow comparisons with previous research, we used the 15 items most frequently used

415

by Aiken and colleagues; that is, the items that form

3 subscales: nurse autonomy, nurse control over the
practice setting, and nurses relations with physicians.These items were derived from organizational
traits reported by magnet hospital staff nurses as
being characteristic of their professional work environments.40 Items were rated on a 4-point Likert
scale and were summed and averaged to yield the 3
subscales.These subscales have consistently demonstrated acceptable internal consistency reliability
across studies (Cronbach alpha: autonomy, .75 to
.78; control, .79; and nurse-physician relations, .73 to
.76).3,39 The overall NWI-R Cronbach alpha reliability
has been reported as .96.1 In this study, the alpha reliability coefficients were 0.88 for the total scale,
0.79 for the autonomy subscale, 0.76 for the control
over practice subscale, and 0.89 for the collaboration subscale (Table 1).
The Global Job Satisfaction Questionnaire
(GJSQ) is a 4-item global measure of job satisfaction
adapted from Hackman and Oldhams41 Job Diagnostic Survey.12 Individuals rate items on a 5-point Likert
scale. This measure has acceptable internal consistency reliability (0.83).14,23 In this study, the Cronbach
alpha reliability was 0.84.

ported in the literature.12 The NWI-R scores are

somewhat lower than those of magnet hospitals in
Aikens work3,39 (Table 3). They were consistent,
however, with those of a large Ontario sample of
nurses in a study reported by Laschinger.30 As hypothesized, the total empowerment score was
strongly related to the total NWI-R score (r .61, P
.0001). All empowerment structures were significantly related to the overall NWI-R score (Table 4),
the most strongly related being the resources subscale (r .55). Consistent with the second hypothesis, both empowerment and magnet hospital characteristics were significant independent predictors
of job satisfaction, explaining 41.5% of the variance
( .51 and .20, respectively).
Study 2
Design and sample

The data drawn for this study were part of a larger

study of nurses who worked in a network of 8 rural
community hospitals in western Ontario. In the original study, nurses responded to questionnaires distributed in their pay envelopes with instructions to
return the completed questionnaires to a research
office in a local university. The return rate was 77%
(n 531). Details of this study can be found in TuerHodes.42 The sample for the current analysis consisted of 263 nurses in nonmanagement roles from 3
hospitals that provide tertiary care. Nurses worked
full-time (42.4%) or part-time (56.9%) in medical-surgical (34.2%), critical care (39.9%), maternal child
(18.1%), and psychiatric (7.8%) specialty areas. Most
were diploma prepared (92%). Respondents aver-

Results
Nurses believed that their job settings were moderately empowering (M 17.9, SD 3.31) and had
moderate levels of magnet characteristics (M 2.68,
SD 0.55).These empowerment scores are consistent with those of other studies of staff nurses re-

Table 3. Means and Standard Deviations for Nursing Work Index Subscales

Study 1
(n 233)

Study 2
(n 263)

Study 3
(n 55)

Laschinger,
Shamian and
Thomson
(2001)

Instrument

Mean

SD

Mean

SD

Mean

SD

Mean

SD

NWI-R
Autonomy
Control over
practice
Registered nursephysician
collaboration

2.68
2.59
2.60

.55
.65
.60

2.78
2.76
2.71

.50
.56
.59

3.20
3.24
2.96

.46
.49
.50

2.53
2.51
2.34

.23
.27
.28

2.99
3.01
2.95

2.83
2.86
2.65

3.08
3.40
3.24

2.49
2.84
2.48

2.87

.72

2.97

.65

3.40

.56

2.86

.30

3.03

2.98

2.16

1.93

Aiken,
Havens, and
Sloane (2000)

Aiken
and Patrician
(2000)

ANCC Original
NonMagnet Magnet Magnet magnet

ANCC, American Nurses Credentialing Center; NWI-R, Nursing Work Index.

416

JONA Vol. 33, No. 7/8 July/August 2003

Table 4. Correlations Between Major Study Variables

Variables
Total empowerment
Opportunity
Information
Support
Resources
Formal power
Informal power
Global empowerment
Satisfaction

Study

Total
NWI-R

Autonomy

1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3

.605*
.493*
.572*
.277*
.139
.297
.397*
.244*
.519*
.377*
.301*
.385*
.546*
.543*
.399*
.422*
.379*
.366*
.442*
.345*
.416*
.540*
.546*
.474*
.503*
.542*
.520*

.593*
.462*
.519*
.279*
.180*
.149
.423*
.252*
.480*
.436*
.326*
.389*
.390*
.416*
.368*
.454*
.383*
.286
.416*
.264*
.473*
.512*
.497*
.408*
.486*
.437*
.388*

Control Over
Practice
Collaboration
.482*
.394*
.585*
.152
.057*
.363*
.286*
.199*
.523*
.268*
.179*
.368*
.627*
.574*
.448*
.342*
.311*
.394*
.299*
.247*
.340
.467*
.472*
.490*
.384*
.489*
.571*

.438*
.346*
.348*
.323*
.140
.249
.300*
.128*
.320*
.238*
.270*
.227
.235*
.223*
.147
.239*
.204*
.253
.449*
.386*
.284
.355*
.339*
.314*
.418*
.373*
.368*

Satisfaction
.625*
.394*
.692*
.397*
.198*
.388*
.424*
.144
.477*
.437*
.351*
.636*
.338*
.377*
.455*
.521*
.256*
.543*
.398*
.185*
.359*
.739*
.518*
.853*
-

*P .05.
P .01.
NWI-R, Nursing Work Index.

aged 44 years of age (SD 8.06), with 22 years of

nursing experience (SD 8.76) and 12 years experience in their current workplace (SD 8.55).

ity (alpha .87). In this study, the Cronbach alpha

reliability was 0.88.
Results

Instrumentation

Nurses completed the CWEQ-II, the NWI-R, and the

NJSQ.36 The alpha reliability coefficients for the empowerment measures ranged from 0.65 to 0.85, 0.82
for the total scale.The CWEQ-II also correlated positively with the measure of global empowerment
(r .58), further supporting the construct validity
of the modified instrument. Alpha reliability coefficients for the NWI-R were 0.87 for the total scale,
0.78 for the autonomy subscale, 0.75 for the control
over practice subscale, and 0.85 for the collaboration subscale.
The NJSQ is a 7-item scale that measures nurses
perceptions of job satisfaction on their work units.
Items are rated on a 6-point Likert scale, then
summed and averaged to create a total score. The instrument has excellent internal consistency reliabil-

JONA Vol. 33, No. 7/8 July/August 2003

Nurses in these hospitals also believed that their job

settings were moderately empowering (M 18.37,
SD 2.82]), slightly higher than the cross province
sample and consistent with those of other studies of
staff nurses reported in the literature.12 NWI-R scores
were also moderate (M 2.78, SD 0.50), and consistent with those of the original magnet hospitals in
Aikens research.3,39 Again, the total empowerment
score was strongly correlated with the total NWI-R
score (r .49, P .0001).
Similar to the Study 1 results, all empowerment
subscales were significantly related to the overall NWIR score (r .54), with resources the most strongly related (Table 4). Both empowerment and magnet hospital characteristics were significant independent
predictors of job satisfaction explaining 31.5% of the
variance (R . 315, F 59.3, df 2,258, P .0001;

417

 . 17 and . 49, respectively). Thus, both hypotheses were supported in these data.
Study 3
Design and Sample

The data for this study were drawn from a larger

study of nurse practitioners perceptions of workplace empowerment. Questionnaires were mailed to
all registered nurses who worked as acute care
nurse practitioners (ACNP) in the province of Ontario. Sixty-three ACNPs from all areas of Ontario
constituted the final sample (return rate 68%). Details of this study can be found in Almost and
Laschinger.16 Nurse practitioners who indicated they
worked in a hospital were retained in the sample for
the analysis reported here (n 55). ACNPs averaged
41 years of age (SD 5.69), with 18 years of nursing
experience (SD 6.83), 5 years of nurse practitioner experience (SD 3.18), and 10 years experience in their current workplace (SD 6.53). Most
(98.2%) were masters prepared.
Instrumentation

ACNPs completed the CWEQ-II, NWI-R, and GJSQ.

The alpha reliability coefficients for the empowerment measures ranged from 0.57 to 0.90. The
CWEQ-II also correlated positively with the measure
of global empowerment (r .72), further supporting
the construct validity of the modified instrument.The
NWI-R alpha reliabilities were 0.88 for the total scale,
0.79 for the autonomy subscale, 0.74 for the control
over practice subscale, and 0.84 for the collaboration
subscale.The alpha for the GJSQ was 0.84.

Results
Nurse practitioners ratings of work empowerment
were higher than those in either sample of staff
nurses (M 20.96, SD 3.08) as were their ratings
of workplace magnet hospital characteristics
(M 3.20, SD 0.46). Their empowerment
scores were similar to those of nurse managers
in previous research. 20,43 NWI-R scores were similar to those of staff nurses in magnet hospitals in
Aikens work.3,39 The study hypotheses were also supported in these data. Similar to the findings of Studies
1 and 2, the total empowerment score was strongly
correlated with the total NWI-R score (r .57,
P .0001). Again, access to empowerment structures was significantly related to the overall NWI-R
score (Table 4). However, in contrast to the studies
with staff nurses, access to information was most
strongly related to the overall NWI-R (r .52).

418

The combination of empowerment and magnet

hospital characteristics were significant predictors
of job satisfaction, explaining 50% of the variance
(R .502, F 26.25, df 2,52, P .0001; .59,
and .19, respectively).
There was some support for Aikens 1 claim that
nurses who work in more specialized areas are more
likely to experience positive working conditions based
on their more homogeneous knowledge and experience.2 Nurse practitioners NWI-R scores were considerably higher than those of the staff nurses in the other
samples. Acute care nurse practitioners are highly specialized in a particular field and thus enjoy greater autonomy and control over their work,as well as close relationships with physicians. In one community hospital
in Study 2, nurses who worked in maternal-child and
psychiatric specialties had significantly higher NWI-R
scores than those on general medical-surgical units.
These differences were not observed, however, in the
broader cross-province sample of nurses.

Discussion
The results of the analyses of these 3 independent
data sets support the hypotheses proposed in this
study linking structural empowerment and magnet
hospital characteristics. The results support the idea
that work environments that provide access to information, support, and resources and opportunities to
learn and grow, as well as flexible job activities and
strong alliances with coworkers, including physicians,
can create work settings that support professional
practice in the magnet hospital research.
Access to resources was strongly related to magnet
hospital characteristics in all samples but was the most
important empowerment structure for staff nurses in
both urban teaching hospitals and rural community
hospitals.This is consistent with Aikens belief that sufficient staffing to allow high-quality professional nursing care is a key component of magnet hospital work
environments. Adequate staffing makes it possible to
have the time to deliver the kind of care nurses expect
of themselves. When this is not possible, nurses often
feel frustrated and betrayed by management.
In all groups, access to support was also important.When nurses work with others who are supportive, practicing in a truly autonomous manner is more
feasible, increasing opportunities to be creative, productive, and effective.44 Research has shown that
nurses who perceive their managers to be collaborative and supportive are more satisfied and more likely
to stay with an organization.45,46 Nurses in Stichlers47
study were more satisfied in work environments char-

JONA Vol. 33, No. 7/8 July/August 2003

acterized by a spirit of teamwork and by responsive

and considerate management, in which nurses were
given authority and autonomy to make decisions regarding patient care.
Both formal and informal power were important
predictors of magnet hospital characteristics. The
importance of good alliances with peers and other
health professionals supports Aikens claim that good
nurse-physician relationships are key features of magnet hospital settings. Effective alliances are possible
when there is mutual respect among parties and commitment to common goals (in this case, high-quality
care).48 When relationships are grounded in mutual
trust and respect, communication is enhanced, greater
levels of cooperation and shared decision making are
possible, assertiveness is less threatening, and coordination of patient care is optimized.49 Lack of collaboration can lead to fragmentation of care, patient dissatisfaction, and poor outcomes. Also, the importance of
having a job that is structured to allow flexibility in the
way work gets done is consistent with the idea that
the nature of professional work is not routine and
must be flexible enough to allow individualized attention to client situations to be effective. Nurse autonomy is constrained when roles are structured according to a rigid set of rules and regulations that
hinder nurses ability to act in a timely manner based
on their expert judgments of the clients status.
Access to information was positively related to
nurses perceptions of magnet hospital characteristics in their work settings. However, for the community hospital nurses, the relationship was not as
strong as in the other samples. This could be result
from access to information not being an issue in
these small rural hospitals, in which size made information sharing possible. On the other hand, access
to information was the most important empowerment structure for nurse practitioners. Nurse practitioners often serve as coordinators for the healthcare team by obtaining test results; communicating
patients needs and care with other healthcare
providers; communicating with physicians, staff
nurses, and families; and referring patients to other
specialized services. Therefore, obtaining timely information from others is key and benefits the organization as well as the patient. When timely information is available, needless treatment delays are
avoided. This allows nurse practitioners to execute
their role professionally.
The various dimensions of empowerment were
significantly related to all magnet hospital features.
All empowerment structures were significantly related to perceptions of autonomy in the work set-

JONA Vol. 33, No. 7/8 July/August 2003

ting, although access to resources and support were

the most important (Table 5). Access to resources
was the most strongly related empowerment structure to control over practice environment in all studies. Informal power was most strongly related to positive nurse-physician relationships. These relationships are theoretically logical and consistent with
numerous studies of these variables in the literature
from other perspectives.
The results of these 3 studies from different
nursing populations provide evidence for the link
between empowerment and magnet hospital characteristics. These results support the relevance of
using strategies derived from Kanters theory of
workplace empowerment in attempts to create
nursing work environments that foster professional
nursing practice and promote job satisfaction and
commitment among staff nurses. See Figure 2 for a
summary of the key findings.

Limitations
The limitations of this study are related to limitations
associated with each of the 3 studies. Given the
cross-sectional nature of these studies, the findings
must be viewed with caution. As is the case with
most mail surveys, none of these studies achieved
100% return, limiting the generalizability of the findings to a certain extent. Although the subjects in
Study 1 were randomly selected from throughout
the province, only nurses with complete data for the
two measures were used in the analysis reported in
this article. In Study 2, the sample is limited to nurses
working in 3 community hospitals in 1 geographic
area in the province. The experience of participants
in these settings may differ from those in other settings.Also, Study 2 nurses completed a different job
satisfaction tool, making strict comparison of results
to the other studies problematic. In Study 3, although all available nurse practitioners from the
provincial college list were surveyed, it is possible
that some may have been omitted from the sampling
frame if they did not provide the college with permission to use their names for research purposes.
Replication of the study with other samples would
provide an opportunity to test the hypotheses across
a wider sample. However, the support for the hypotheses proposed a priori allows generalization to
theory and offsets these limitations somewhat.50

Implications for Nursing Administration

Nursing administrators can use the results of this research by examining workplaces for structural factors

419

Table 5. Average Correlations Across Studies

Total Magnet Hospital
Characteristics Score
Total empowerment score
Resources
Informal power
Formal power
Information
Support
Opportunity

Autonomy

.556
.496
.401
.389
.386
.354
.234

that act as barriers to staff nurses access to empowerment structures that can support professional practice; that is, nurses autonomy, control over the practice environment, and good nurse-physician
relationships. According to Clifford,51 professional
practice is impossible without support systems that
remove barriers between nurses and patients. Care
systems and structures that maximize the use of
the clinical expertise of nurses are critical to
achieving this goal. To enable truly professional
practice, managers will have to focus less on control and more on the coordination, integration, and
facilitation of nurses work. This can be accomplished by providing access to information, resources, and support that are needed to achieve
professional and organizational goals.
Nurses must have input into the design of their
work environments if such structures are expected
to empower nurses in their practice. Control over
the context of nursing practice environments may
be increased by management support of participa-

.524
.391
.381
.374
.381
.385
.202

Control Over
Practice Environment
.487
.549
.295
.349
.336
.271
.190

Collaboration
.377
.201
.373
.232
.249
.245
.237

tive management practices, shared governance systems, decentralization, and the creation of autonomous work units. Patient-focused care systems
emphasize point-of-care decision making and the importance of alliances with other healthcare team
members, calling to mind Kanters claim for the importance of informal power in organizations for accomplishing work.
Nurses access to information about organizational policies and happenings can be increased by
means of information hotlines on voicemail or email systems. Management can stay in touch with
staff through periodic surveys and in regularly
scheduled open forums to discuss work issues.
Sharing information openly and honestly builds
trust in the organization. Visibility of nurse managers at all levels in the clinical setting is an important indicator of support and gives clinical nurses
the opportunity to demonstrate their clinical expertise and to be recognized for their skills. It is
crucial that all levels of nursing management are

Greater access to workplace empowerment structures resulted in:

higher perceptions of autonomy
increased control over the practice environment
positive nurse/physician relationships
All empowerment structures were important influences on magnet hospital
characteristics with:
access to resources and support having the greatest impact on control over
practice and autonomy
informal power having the strongest impact on nurse/physician relationships
Access to empowerment structures increased perceptions of magnet hospital characteristics in the work place, which, in turn, increased job satisfaction (average R 2 = 0.41)
Figure 2. Key findings.

420

JONA Vol. 33, No. 7/8 July/August 2003

genuinely committed to a shared vision fostering

empowered behavior in staff.
Finally, access to opportunities to learn and
grow is an important component of a hospitals magnetism. Professional development programs, including inservice and continuing education programs for
both staff and managers, are important mechanisms
for continuously improving staff knowledge and expertise. Clinical advancement programs, such as career ladders, provide a means for recognizing nurses
experience and expertise. Other strategies that can
be used to increase perceptions of empowerment
and the creation of magnetizedwork environments
can be found elsewhere.52,53

empirically supported in data from independent

studies conducted in 3 different nursing populations. Although further research is needed to validate this work, the findings of this study are both relevant and timely for nursing administrators who are
faced with work environment constraints that demand doing more with less, yet preserving the essential elements of professional nursing practice. As
nursing faces yet another shortage, every effort must
be made to create work environments that attract
and retain highly qualified professional nurses to ensure that patients continue to receive the quality of
care they deserve and that the profession continues
to maintain high standards of nursing practice.

Summary and Conclusions

Acknowledgments

The results of this study support the proposed link

between Kanters work empowerment structures
and Aikens notion of magnet hospital characteristics. Theoretically proposed relationships between
workplace empowerment and features of magnet
hospitals that support professional practice were

Funded by Nursing Administrators Interest Group of

Registered Nurses Association of Ontario (RNAO),
Nursing Research Interest Group of RNAO, Iota Omicron Chapter of Sigma Theta Tau, University of Western Ontario School of Nursing, and SSHRC Extramural Grants Program Grant #410-99-0377.

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